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 16 October 2017

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GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

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GastroenterologyEsophagus

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Esophageal stricture.
This patient accidentally swallowed something corrosive, and has developed a long smooth stricture at the lower end of the esophagus.

Comment
Although these can be the result of accidental ingestion of acid or alkali, many are the result of deliberate attempts at self-harm. Acids usually produce a coagulation necrosis (through the denaturing of proteins), forming a coagulum that limits penetration of the acid to the mucosal layers. Alkalis typically produce a more severe injury, known as 'liquefaction necrosis'. This involves denaturing of proteins and saponification of fats, and the injury may penetrate all layers of the gut. In the latter circumstances, free perforation is a real risk.

Accidental ingestion of caustic occurs most often in children who gain access to household cleaners. There may be associated burns in the mouth and oro-pharynx. Gastric antral damage is also common. Several weeks may elapse after ingestion of caustic before stricturing occurs. Regular bouginage during this time may overcome any severe degree of stricturing. Long-standing corrosive strictures are associated with a risk (about 10%) of developing malignant change.

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Peter Devitt, Adelaide, Australia

Esophageal stricture.

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